Goldenberg 1996.

Study characteristics
Methods	Design: cross‐over Duration: 6 weeks Assessment: baseline and post‐intervention Country: USA
Participants	Pain condition: fibromyalgia Population: adults with fibromyalgia Minimum pain intensity: ≥ 30 on 0‐100 VAS Inclusion criteria Aged 18‐60 Fibromyalgia that matches ACR criteria ≥ 30 on 0‐100 pain intensity VAS Exclusion criteria Physical health comorbidities Depression: ≥ 18 on Hamilton Rating Scale for Depression Total participants randomised: 31 Age in years (mean, SD): 43.2 (9.1) Gender: 28/31 were female Pain duration/fibromyalgia symptoms in months (mean, SD): 72.6 (48.1)
Interventions	Placebo Inert Double‐dummy design = 2 tablets per day Amitriptyline 25 mg + placebo TCA Fixed dose Double‐dummy design Fluoxetine 20 mg + placebo SSRI Fixed dose Double‐dummy design Amitriptyline 25 mg + fluoxetine 20 mg Combined intervention: TCA + SSRI Fixed doses Double dummy design
Outcomes	Pain intensity Quality of life Sleep Mood Withdrawal
Missing data methods	Completer analysis only
Funding source	Non‐pharmaceutical: Lot Page Fund, Newton‐Wellesley Hospital, Newton
Conflicts of interest	NR
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Participants were randomised using a table of random numbers
Allocation concealment (selection bias)	Low risk	Randomisation and allocation was performed in the hospital pharmacy
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Identical tablets and double‐dummy to match dosing schedules across groups
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Self‐reported outcomes from blinded participants
Incomplete outcome data (attrition bias) All outcomes	High risk	Completer‐only analysis, unequal attrition across arms and high overall dropout Attrition Total: 12/31 (38.7%) Placebo: 1/31 (3.2%) Amitriptyline 25 mg: 1/31 (3.2%) Fluoxetine 20 mg: 4/31 (12.9%) Amitriptyline 25 mg + fluoxetine 20 mg: 5/31 (16.1%)
Selective reporting (reporting bias)	Unclear risk	No protocol or trial registration found
Other bias	Low risk	No other sources of bias were identified